HomeMy WebLinkAbout52503-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52503 Date: 12/02/2025
Permission is hereby granted to:
Sean Southard
28 Bayview Ave
Port Washington,NY 11050
To:
Legalize as built additions and alterations to include an HVAC system and rear deck as applied for.
Premises Located at:
730 Sebastians Cove Rd, Mattituck, NY 11952
SCTM# 100.-3-11.6
Pursuant to application dated 10/22/2025 and approved by the Building Inspector.
To expire on 12/02/2027.
Contractors:
Required Inspections:
Fees:
As Built Deck $465.00
As Built HVAC $500.00
CO Single Family Dwelling-Addition/Alteration $100.00
Total $1,065.00
J,,r"'.
Building Inspector __.
� F'R?d�^f� �,
s TOWN OF SOUTHOLD — BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
p ( ) ( ) https�/,/www.southoldtowtiny,_gov
Telephone 631 765-1802 Fax 631 765-9502 .tt s:�a v�^'ti�w. otathojdtc� `��r� v,
Date Received
APPLICATION FOR BUILDING PERMIT
LJ Lea , lu ti
For Office Use Only
PERMIT NO. Building Inspector., SAK E n^T fir„ ,:) d
P l , tf ►ps arr forms must be,filled,art m thelr a tlrety Incomplete
eplalr et wall raft he a epteal: ere the A 1iMn is not the owner, �f� �
Ig "-�� ' t
tltOf,*lll�rl l"oMtt""' ` �shall be c� i
OW{I N1N
Date:
OWNER(5)OF PROPERTY.
Name: SCTM# 1000-
Project Address: 7
3V �jol f�.�.�d� LASJ
�s
Phone #: I 67(>7 - ' �r), Email: 556v f ka @ I tg I "•�
Mailing Address: 0 VCew FoRr WA-5 if 14J6 /y ILe5-?5
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Re air ❑Demolition Estimated Cost of Project:
Other $
Will the lot be re-graded? ❑Yes El No �6 Will excess fill be removed from premises? ❑Yes ❑No
Eck
PROPERTY INFORMATION'
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restr ons with respect to
this property? Dyes ❑No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,"Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): Sr.-� ❑Authorized Agent Owner
Signature of Applicant:
N IE D.BUNCH Date: /
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,County
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
i, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2